Access to the outdoors: using photographic comparison to assess preferences of assisted living residents

Older adults in long-term care facilities have been found to value spending time outdoors, and studies suggest they may potentially derive health benefits. To better understand how the physical environment supports outdoor usage in assisted living, findings from a previous study using verbal assessments (focus groups and written surveys), were further examined with visual assessment techniques. Using multi-stage cluster sampling, facilities (n = 14) and residents (n = 133) were randomly selected from all larger facilities (50+ resident capacity) in a 12-county region of south central Texas. Residents were asked to choose the image they preferred in each pair of large color photographs depicting outdoor areas and transition zones at a variety of assisted living facilities. In each pair, a single environmental variable was digitally modified in one of the images, to represent one of six constructs being tested. Data were analysed by how many of the four possible examples subjects chose for each construct. Responses significantly favored the hypothesized constructs, and generally supported the relevant behavioral research and design literature. By isolating individual elements, this study helped identify specific environmental features preferred by residents, for possible application toward facility design. Paired photographic comparison was found to be a feasible way to test environmental preferences in assisted living residents.